Published online Jan 28, 2021. doi: 10.3748/wjg.v27.i4.336
Peer-review started: October 9, 2020
First decision: December 3, 2020
Revised: December 11, 2020
Accepted: December 22, 2020
Article in press: December 22, 2020
Published online: January 28, 2021
Processing time: 107 Days and 15.1 Hours
Metabolic associated fatty liver disease (MAFLD) is a novel concept proposed in 2020.
To compare the characteristics of MAFLD and MAFLD with hepatitis B virus (HBV) infection.
Patients with histopathologically proven MAFLD from a single medical center were included. Patients were divided into MAFLD group (without HBV infection) and HBV-MAFLD group (with HBV infection). Propensity score matching was utilized to balance the baseline characteristics between two groups.
A total of 417 cases with MAFLD were included, 359 (86.1%) of whom were infected with HBV. There were significantly more males in the HBV-MAFLD group than in the MAFLD group (P < 0.05). After propensity score matching, 58 pairs were successfully matched with no significant differences found in gender, age, body mass index, lipid levels, liver enzymes, and the other metabolic associated comorbidities between the two groups (P > 0.05). The rank sum test results showed that the degree of liver steatosis in the MAFLD group was more severe than that in the HBV-MAFLD group, while the degree of inflammation and fibrosis in the liver was less severe (P < 0.05). In multivariate analysis, HBV infection was associated with significantly lower grade of hepatic steatosis [odds ratio (OR) = 0.088, 95% confidence interval (CI): 0.027-0.291] but higher inflammation level (OR = 4.059, 95%CI: 1.403-11.742) and fibrosis level (OR = 3.016, 95%CI: 1.087-8.370) after adjusting for age, gender, and other metabolic parameters.
HBV infection is associated with similar metabolic risks, lower steatosis grade, higher inflammation, and fibrosis grade in MAFLD patients.
Core Tip: Metabolic associated fatty liver disease (MAFLD) is a novel concept proposed in 2020 aiming to replace the previous definition of non-alcoholic fatty liver disease. Patients with MAFLD have different features from those with non-alcoholic fatty liver disease because MAFLD does not require the exclusion of other chronic liver disease, such as hepatitis B virus (HBV) infection. In this study, we compared the characteristics of patients with and without HBV infection in a biopsy-proved MAFLD cohort. The results of this study involving 417 participants showed that cases with HBV-MAFLD had similar metabolic features as pure MAFLD, and the presence of HBV infection was associated with lower steatosis grade but higher inflammation and fibrosis grade in MAFLD. These results highlight the importance of the monitoring and managing HBV infection in MAFLD.